Monday, March 29, 2010

It's About Us

Today I finished reading Barack Obama's Dreams From My Father. One of the remarkable things about this fine book is its heteroglossia, to use a 25-cent grad school term. Obama lets the people in his memoir speak at length, bringing a multiplicity of voices and viewpoints into his narrative.

His Indonesian stepfather's rather brutal view of power, for instance: "If you can't be strong, be clever and make peace with someone who's strong. But always better to be strong yourself. Always."

Or the despair of a counselor at a Chicago public school: "The first thing you have to realize is that the public school system is not about educating black children. Never has been. Inner-city schools are about social control.... They're operated as holding pens—miniature jails, really."

And, in a fascinating section near the end of the book, nearly thirty pages long, Obama gives the narration over to his Kenyan "Granny," who tells him the life stories of his grandfather (her husband) and his father (whom she raised).

Obama doesn't necessarily agree with all of the voices that he incorporates into his memoir, but neither does he set them up as strawmen to mow down with his own answers. Instead, Obama lets their words stand, using them as landmarks while charting his own thoughtful ruminations.

Near the end of the book, Obama has dinner with a Kenyan history professor, who asks him if he's been disappointed by his first visit to her country. "I told her that I hadn't," he notes, "although I was leaving with as many questions as answers."

Obama stays true to the complexities of identity, race, class, politics, colonialism, meaning, and more by avoiding easy answers, remaining "wary of expedient conversion, having too many quarrels with God to accept a salvation too easily won."

Dreams From My Father takes on an added dimension of significance, of course, now that its author is the 44th president of the United States. And it struck me today, reading this Atul Gawande piece about what lies ahead in implementing the recently passed health care bill, that Obama's governance reflects the same temperament as his memoir.

Gawande notes:

The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving health-care innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.

That’s the one truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success. We are the ones to determine whether costs are controlled and health care improves—which is to say, whether reform survives and resistance is defeated. The voting is over, and the country has many other issues that clamor for attention. But, as L.B.J. would have recognized, the battle for health-care reform has only begun.

As Obama said during the campaign, "It's not about me; it's about you," and Gawande suggests that in large measure the health care bill leaves it up to the American public to work out various solutions to the health care conundrum, solutions that are appropriate to community needs and resources, solutions that acknowledge the vexing complexity of our country's challenges.

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